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Protecting communities in Myanmar against infection and environmental harm

Daw Khin Ohm Myint, a local midwife, cuts a needle with a manual needle cutting device after giving a vaccine during an outreach immunization session in Thit Ael Pin village in Pindaya. Photo: UNICEF/Nyan Zay Htet.

PATH promotes sustainable and environmentally friendly health care by introducing systems to manage health care waste. In Myanmar, PATH and UNICEF's project has tested and recommended new strategies and devices for waste management and trained health staff on improved ways of working.

Strengthening immunization systems in Myanmar

In Myanmar, the introduction of nationwide vaccine campaigns is a cause for celebration, as many newborns, children, and adults are immunized against severe vaccine-preventable illnesses. In a small village in Pindaya Township, Daw Khin Ohm Myint (pictured above) and her colleagues work in a rural hospital hidden away in the mountains. Outreach health workers travel on their motorbikes from village to village to gather parents and newborns for monthly immunization sessions, held in community centers and local monasteries.

In 2018, Mong In Hospital in Pindaya won an award for being the model hospital and pilot site for injection control and health care waste management. With PATH’s support, all 19 of the township’s public health facilities have adopted new ways of segregating and disposing health waste, ways that promote sustainable and environmentally friendly health systems and prevent infection and health risks.

However, for many years, vaccine waste—including sharp needles, syringes, and glass bottles—have been left in communities and not disposed adequately. Without appropriate waste management, community members have thrown vaccine waste in forests or tried to burn, bury, or cut them manually with little success.

In the past, some health facilities in Pindaya tried their own waste disposal methods: “We kept used needles in water bottles and small safety boxes made from cardboard, but they were often full and needles could spill out,” explained Daw Thet Tue Mar from Pindaya Township Hospital.

The harms of vaccine waste

Poor health care waste management can lead to accidents and health hazards, including needle-stick injuries and infections. An infectious needle can carry a risk of hepatitis B, hepatitis C, and HIV infection. The risk exists for everyone, including health workers, ordinary community members and children playing outside, and waste scavengers.

Similarly, poor waste management contributes to air and water pollution. Open burning of plastic, including syringes, can be as harmful as burning the oil that the plastic is made from, leading to black fumes and an overpowering smell spreading in the towns.

People in Pindaya used to complain about the black smoke that filled the air from the burning of waste. According to Daw Yee Yee Naing from Myin Mu subcenter, “The fumes affected community health.” Myanmar is among the top 20 countries with the highest air pollution in the world, largely caused by burning of waste.

Also, needles are not properly destroyed in open burning. Villagers in Pindaya have come across half-burned needles in the village’s agricultural fields.

PATH’s two-year health care waste management project has aimed to test and design ways in which waste from health care, including sharps, can be managed. The project, supported by UNICEF, piloted these approaches in 55 health facilities in Myanmar’s two regions: hilly and remote Shan State, where Pindaya Township is located, and in Hmawbi Township in peri-urban Yangon.

PATH took a comprehensive approach to its project, working on governance and guidelines; introduction of new devices, systems, and tools; curriculum development and training for health staff; and monitoring and evaluation of its approach.

PATH trained all 300 midwives and nurses in Pindaya and Hmawbi on new ways of working, including using needle cutters and pits and segregating waste. Photo: PATH/Minzayar Oo.

The project introduced new manual devices called needle cutters that health staff can use to cut and “defang” syringes. The cutter separates and cuts the sharp needle into the box and allows for the plastic syringe to be collected for disinfection and recycling. PATH has also introduced this technology in other countries, such as in India, Senegal, Uganda, and Vietnam.

PATH’s project in Myanmar also established a four-tiered color-coded waste segregation system with appropriate waste bins and provided disinfection materials for plastic syringes. In Kyone subcenter, the staff painted their existing bins in line with instructions they received at PATH’s training: “After the training, we were eager to start the process.”

The project also built different types of needle pits—secured disposal sites for needles—outside health facilities, where used needles can be safely disposed. Some health facilities were pioneers and got the community to join the construction process. In Myin Mu, the husband of a midwife got involved in designing and building a sharp barrel for the rural health center using local materials and contractors.

Thet Htoo Mar, a trained nurse, uses a needle cutter after giving injections to patients. The cutter separates and cuts the sharp needle into the box. Photo: UNICEF/Nyan Zay Htet.

The needle pit, built outside the health facility, is a secured disposal site for needles where used needles can be safely disposed. Photo: UNICEF/Nyan Zay Htet.

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Ei Ma, an auxiliary midwife, uses a twin bucket system and chlorine to disinfect plastic syringes. After disinfection, plastic syringes are sold to plastic collectors and recycled for other plastic use. Photo: UNICEF/Nyan Zay Htet.

The waste bins are transported to a disposal site, where they will be collected by the township's waste department. Photo: UNICEF/Nyan Zay Htet.

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The project also secured government stewardship by establishing a technical working group and two township steering committees. Government representatives from the occupational and environmental health division and the central Expanded Programme on Immunization are involved to ensure that the project is sustainable and in line with national priorities in Myanmar.

In Pindaya, the township medical officer, Dr. Moh Moh Kyi, leads the process and the township’s steering committee. She wants Pindaya to be a model township in Myanmar: “I’m happy that Pindaya was selected as the pilot township for this project. Our 19 public centers have been involved in learning and applying systematic and best practices in waste management. Now we’re encouraging other townships to follow our example.”

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Our health centers have been learning and applying best practices in waste management. Now we’re encouraging other townships to follow our example.
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— Dr. Moh Moh Kyi, township medical officer, Pindaya

Environmental practices in health care—reduce and recycle

PATH’s project aims to play its part towards environmental health and sustainable development. After separating, disinfecting, and collecting plastic syringes, syringes used in vaccination can be recycled in an environmentally friendly and sustainable manner.

After disinfection, syringes are sold to plastic recycling businesses. This practice was previously discouraged as dirty and infected syringes, sometimes with sharp needles, should not be reused. Now, syringes are disinfected and the plastic can be broken down and used for other plastic products.

“Plastic collectors come every two months to collect the disinfected plastic syringes. From selling syringes we can get some extra money that we can use for our clinic,” Daw Nyo Nyo Seint, a local midwife, explained. Some clinics trade syringes for onions or other household items: “It’s a fun practice,” she added. Plastic recycling businesses are also making an income, as they sell the plastic onwards to other businesses.

Plastic syringes are collected and disinfected so that can be sold to recycling businesses. Photo: UNICEF/Nyan Zay Htet.

From successful pilot to national scale-up

After the pilot wraps up in January 2020, PATH, UNICEF, and project partners will support the government to scale up the project in all 330 townships in Myanmar, with funding support from the World Bank.

Based on the model and materials developed by PATH, the Ministry of Health and Sports will procure needle cutters and build needle pits for all townships, as well as provide training for all basic health staff. Needle cutters will also be used in all future vaccination campaigns. The standard operating procedures for health care waste management, developed by PATH, will also be integrated into national-level health care waste management guidelines. Through this learning experience in immunization waste management, we are helping Myanmar take an important step toward a safer, environmentally friendly, and comprehensive approach to immunization service delivery.

Daw Yee Yee Naing, a local health worker in Pindaya Township in Myanmar.

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Through this learning experience, we are helping Myanmar take an important step toward a safer and environmentally friendly approach to immunization service delivery.
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